NPI 1194162230 · live from the CMS NPI Registry
Matthew Ryan Clark, M.D.
Dermatology, MOHS-Micrographic Surgery in Bend, OR. National Provider Identifier 1194162230, active.
NPI record
| NPI | 1194162230 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Dermatology, MOHS-Micrographic Surgery 207ND0101X |
| Practice location | 2353 Ne Conners Ave, Bend, OR 97701 |
| Practice phone | 541-323-7546 |
| Enumerated | May 30, 2013 |
| Last updated | July 21, 2026 |
| Sole proprietor | Yes |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Dermatology | 207N00000X | MMD89666MD (SC) |
| Dermatology, MOHS-Micrographic Surgery | 207ND0101X | MMD89666MD (SC) |
| Dermatology | 207N00000X | 2023-00924 (NC) |
| Dermatology, MOHS-Micrographic Surgery | 207ND0101X | 2023-00924 (NC) |
| Dermatology, MOHS-Micrographic Surgery primary | 207ND0101X | MD195653 (OR) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.